This form contains 33 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Authorization
Title Text
Enter the title of the authorized officer signing the form.
PTIN Text
Enter the Preparer Tax Identification Number (PTIN). The maximum length is 11 characters.
Max length: 11 characters
Company Information
Firm's name Text
Enter the full legal name of the regulated investment company (RIC).
Firm's EIN Text
Enter the Employer Identification Number (EIN) of the regulated investment company. This should be a 9-digit number.
Max length: 10 characters
b536 Firm's address Text
Enter the complete address of the regulated investment company, including street address, city, state, and ZIP code.
Phone no Text
Enter the phone number of the regulated investment company, including area code.
Distributions
7a Distributed amount for the previous calendar year under section 4982(c). Enter amount from line 3b. 7a Text
Enter the distributed amount for the previous calendar year under section 4982(c). This should be the amount from line 3b.
b Grossed up required distribution for the previous calendar year Text
Enter the grossed-up required distribution for the previous calendar year.
7c Text
Enter the amount for line 7c as specified in the form instructions.
Election
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Check this box if applicable as per the form instructions.
Financial Information
1b b Multiply line 1a by 98% (0.98) Text
Enter the result of multiplying the amount on line 1a by 98% (0.98).
2a Text
Enter the amount for line 2a as specified in the form instructions.
b Multiply line 2a by 98.2% (0.982) 2b Text
Enter the result of multiplying the amount on line 2a by 98.2% (0.982).
topmostSubform[0].Page1[0].f1_10[0 Text
This field is likely for additional financial information. Refer to the form instructions for the exact value to enter here.
b Distributed amount for the previous calendar year under section 4982(c) . 3b Text
Enter the distributed amount for the previous calendar year under section 4982(c).
C Subtract line 3b from line 3a. If zero or less, enter -0--3c Text
Subtract the amount on line 3b from the amount on line 3a. If the result is zero or less, enter -0-.
4 4 Required distribution. Add lines 1b, 2b, and 3c Text
Enter the required distribution by adding the amounts on lines 1b, 2b, and 3c.
5 Text
Enter the amount for line 5 as specified in the form instructions.
8 00 Text
Enter the amount for line 8 as specified in the form instructions.
topmostSubform[0].Page1[0].f1_21[0 Text
Enter the amount for this field as specified in the form instructions.
topmostSubform[0].Page1[0].f1_24[0 Text
Enter the amount for this field as specified in the form instructions.
topmostSubform[0].Page1[0].f1_26[0 Text
Enter the amount for this field as specified in the form instructions.
General Information
topmostSubform[0].Page1[0].Pg1Header[0].f1_01[0 Text
This field is likely for a code or identifier related to the form. Please refer to the form instructions for the specific value to enter here.
Max length: 2 characters
Name of fund Text
Enter the full legal name of the regulated investment company (RIC).
Employer identification number Text
Enter the Employer Identification Number (EIN) of the fund. This is a 9-digit number assigned by the IRS.
Max length: 10 characters
Number, street, and room or suite no. If a P.O. box, see instructions Text
Enter the street address, room or suite number of the fund. If using a P.O. box, follow the specific instructions provided in the form.
City or town, state, and ZIP code Text
Enter the city, state, and ZIP code of the fund's address.
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
This checkbox may be used for a specific election or declaration. Refer to the form instructions to determine if this should be checked.
topmostSubform[0].Page1[0].f1_06[0 Text
This field is likely for additional information or a specific code. Refer to the form instructions for the exact value to enter here.
Tax Due
Tax due. Subtract line 11 from line 10. See instructions 12 12 Text
Enter the tax due by subtracting line 11 from line 10. Refer to the form instructions for more details.
Tax Payments
Tax paid with extension of time to file (Form 7004) 11 11 Text
Enter the tax paid with the extension of time to file (Form 7004).
Taxable Income
6 Amount on which tax is imposed under sections 852(b)(1) or 852(b)(3)(A) for any tax year Text
Enter the amount on which tax is imposed under sections 852(b)(1) or 852(b)(3)(A) for any tax year.
Undistributed Income
9 9 Undistributed income. Subtract line 8 from line 4. If zero or less, enter -0 Text
Enter the undistributed income by subtracting line 8 from line 4. If the result is zero or less, enter -0.